<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    {:token()}
    <input type="hidden" name="row[id]" value="{$row.id}">
    <!--账号-->
    <div class="form-group">
        <label for="c-username" class="control-label col-xs-12 col-sm-2">{:__('Account')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-username" data-rule="required" class="form-control" name="row[account]" type="text" value="{$row.account|htmlentities}">
        </div>
    </div>
    <!--姓名-->
    <div class="form-group">
        <label for="c-nickname" class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-nickname" data-rule="" class="form-control" name="row[name]" type="text" value="{$row.name|htmlentities}">
        </div>
    </div>
    <!--密码-->
    <div class="form-group">
        <label for="c-pwd" class="control-label col-xs-12 col-sm-2">{:__('Password')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-pwd" data-rule="pwd" class="form-control" name="row[pwd]" type="text" value="" placeholder="{:__('Leave password blank if dont want to change')}" autocomplete="new-password" />
        </div>
    </div>
    <!--电话-->
    <div class="form-group">
        <label for="c-tel" class="control-label col-xs-12 col-sm-2">{:__('Tel')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-tel" data-rule="mobile" class="form-control" name="row[tel]" type="text" value="{$row.tel|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label for="c-sex" class="control-label col-xs-12 col-sm-2">{:__('Sex')}:</label>
        <div class="col-xs-12 col-sm-8">
            {:build_radios('row[sex]', ['0'=>__('Secrecy'), '1'=>__('Male'),'2'=>__('Female')], $row['sex'])}
        </div>
    </div>
    <!--生日-->
    <div class="form-group">
        <label for="c-birthday" class="control-label col-xs-12 col-sm-2">{:__('Birthday')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-birthday" data-rule="" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[birthday]" type="text" value="{$row.birthday}">
        </div>
    </div>
    <!--头像-->
    <div class="form-group">
        <label for="c-heading_img" class="control-label col-xs-12 col-sm-2">{:__('HeadingImg')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-avatar" data-rule="" class="form-control" size="50" name="row[heading_img]" type="text" value="{$row.heading_img}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-avatar" class="btn btn-danger faupload" data-input-id="c-avatar" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-avatar"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-avatar" class="btn btn-primary fachoose" data-input-id="c-avatar" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-heading_img"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-heading_img"></ul>
        </div>
    </div>
    <!--邮箱-->
    <div class="form-group">
        <label for="c-email" class="control-label col-xs-12 col-sm-2">{:__('Email')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-email" data-rule="" class="form-control" name="row[email]" type="text" value="{$row.email|htmlentities}">
        </div>
    </div>
    <!--身份证-->
    <div class="form-group">
        <label for="c-id_card_number" class="control-label col-xs-12 col-sm-2">{:__('IdCardNumber')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-id_card_number" data-rule="IDcard" class="form-control" name="row[id_card_number]" type="text" value="{$row.id_card_number|htmlentities}">
        </div>
    </div>
    <!--工号-->
    <div class="form-group">
        <label for="c-job_number" class="control-label col-xs-12 col-sm-2">{:__('JobNumber')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-job_number" data-rule="" class="form-control" name="row[job_number]" type="text" value="{$row.job_number|htmlentities}">
        </div>
    </div>
    <!--身份证照片-->
    <div class="form-group">
        <label for="c-id_card_number_img" class="control-label col-xs-12 col-sm-2">{:__('IdCardNumberImg')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-id_card_number_img" data-rule="" class="form-control" size="50" name="row[id_card_number_img]" type="text" value="{$row.id_card_number_img}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-id_card_number_img" class="btn btn-danger faupload" data-input-id="c-avatar" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-avatar"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-id_card_number_img"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-id_card_number_img"></ul>
        </div>
    </div>
    <!--医院-->
    <div class="form-group">
        <label for="c-hospital" class="control-label col-xs-12 col-sm-2">{:__('Hospital')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-hospital" data-rule="" class="form-control" name="row[hospital]" type="text" value="{$row.hospital|htmlentities}">
        </div>
    </div>
    <!--科室-->
    <div class="form-group">
        <label for="c-department" class="control-label col-xs-12 col-sm-2">{:__('Department')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-department" data-rule="" class="form-control" name="row[department]" type="text" value="{$row.department|htmlentities}">
        </div>
    </div>
    <!--职称-->
    <div class="form-group">
        <label for="c-titles" class="control-label col-xs-12 col-sm-2">{:__('Titles')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-titles" data-rule="" class="form-control" name="row[titles]" type="text" value="{$row.titles|htmlentities}">
        </div>
    </div>
    <!--行政职务-->
    <div class="form-group">
        <label for="c-rank" class="control-label col-xs-12 col-sm-2">{:__('Rank')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-rank" data-rule="" class="form-control" name="row[rank]" type="text" value="{$row.rank|htmlentities}">
        </div>
    </div>
    <!--学历-->
    <div class="form-group">
        <label for="c-education" class="control-label col-xs-12 col-sm-2">{:__('Education')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-education" data-rule="" class="form-control" name="row[education]" type="text" value="{$row.education|htmlentities}">
        </div>
    </div>
    <!--个人专长-->
    <div class="form-group">
        <label for="c-specialty" class="control-label col-xs-12 col-sm-2">{:__('Specialty')}:</label>
        <div class="col-xs-12 col-sm-4">
            <input id="c-specialty" data-rule="" class="form-control" name="row[specialty]" type="text" value="{$row.specialty|htmlentities}">
        </div>
    </div>
    <!--认证情况-->
    <div class="form-group">
        <label for="content" class="control-label col-xs-12 col-sm-2">{:__('Attestation')}:</label>
        <div class="col-xs-12 col-sm-8">
            {:build_radios('row[attestation]', ['0'=>__('Unverified'), '1'=>__('Verified')], $row['attestation'])}
        </div>
    </div>
    <!--登录状态-->
    <div class="form-group">
        <label for="content" class="control-label col-xs-12 col-sm-2">{:__('State')}:</label>
        <div class="col-xs-12 col-sm-8">
            {:build_radios('row[state]', ['0'=>__('Disable'), '1'=>__('Enable')], $row['state'])}
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
